The recent and tragic accident in Mumbai has once again highlighted the importance of effective MRI Safety in facilities. Although fatalities and serious injuries as a result of projectiles are thankfully rare, there continues to be a steady stream of reported incidents and near misses. It’s also generally well accepted within the community that reported incidents represent just the tip of the iceberg, with the majority of occurrences remaining undisclosed.
Projectile safety is just one element of MRI safety, alongside a wide range of other concerns that present daily challenges to MRI staff such as: burn prevention, hearing protection, contrast safety, screening quality and decision making around patients with surgical implants.
MRI safety is a complex and ever-evolving area. There is no single magic solution. Instead, we believe the focus should be on a balanced, multifactorial approach. Below we’ve highlighted the areas we feel are critical to an effective approach to MRI safety, along with some guidance on best practice from our own team of experts as well as details of where to find further information.
Education is critical
Education is at the core of all good safety systems. Although in the USA some states allow non-certified technologists to operate in MRI, certification by the ARRT or ARMRIT is, in our opinion, a minimum requirement.
In addition to this, both the ACR and the Joint Commission recommend/require initial and annual MRI Safety focused education. This is extremely important and can be delivered in-person or via a web-based training system like Metrasens’ Ferroguard Academy.
Asked about the best way to approach this, John Posh, Metrasens’ Director of Education said: “Although there is no standard certificate of education for MRI safety there are a range of options. The American Board of Magnetic Resonance Safety (ABMRS) grew out of a grassroots effort at self-governance and is gaining widespread adoption for its MRI Safety Officer (MRSO), MRI Medical Director (MRMD) and MRI Safety Expert (MRSE) certifications. These aren’t required by regulation but they are becoming quality benchmarks for core safety knowledge.”
“The Society for MR Radiographers & Technologists (SMRT) is the primary professional society for MRI technologists and does an excellent job at promoting and supporting MRI Safety. They have dedicated education offerings on their MRI Safety website and have begun a campaign of MRI safety days where technologists can get an entire day of CME devoted solely to MRI Safety.”
“Ideally all facilities would encourage technologists to become active members of the SMRT, pursue MRSO certification, and hold yearly MRI safety lectures for a truly comprehensive safety program.”
“And, of course, social media has become a hive of MRI safety-related activity. Facebook has several MRI safety focused groups including MRI World, UK MRI safety Group, and MRI Safety, an active community with over 17000 members!”
Creating the right environment and processes
Alongside the fundamental need for safety-focused education, the environment in which MRI teams work, and the standard operating procedures that guide their day, also have an important influence in the safety of the facility.
The focus for radiology safety regulations, until recently, was based on the criterion of exposure to ionizing radiation. The absence of ionizing radiation in the MRI modality appears to have therefore categorized it as “safe” and requiring little associated regulation. However, accreditation, licensing, and regulatory bodies are slowly realizing that the absence of risk-related regulation is not proof of safety, and things are changing.
We asked Tobias Gilk, Founding Principal of Gilk Radiology Consultants and Consultant to Metrasens, for his views on this key area: “In the USA, the American College of Radiology (ACR) Guidance Document on MR Safe Practices has been held out as a best practice-defining document since its original publication in 2002. Its influence has really begun to permeate the accreditation and regulatory environment in the US.”
“As regards the physical environment of MRI facilities, the US healthcare design standard is the newly updated and broad-reaching FGI Guidelines. An additional useful resource, although now approaching 10 years old now (and we understand scheduled for major revision in 2019) is The MRI planning tool of the US Department of Veteran Affairs.
“As with everything MRI safety-related, the physical environment is a necessary element to effective safe practices, but is not enough by itself. It must be developed in conjunction with other areas. When the right physical environment is properly combined with training, processes and technology, a vastly safer MRI facility is the result.”
Using technology to enhance safety
The safety of many activities and workplaces has been significantly enhanced by the application of intelligently directed technology, and MRI is no exception.
Ferromagnetic detection systems (FMDS) such as Metrasens’ Ferroguard systems are an example of this. They detect objects that can be potentially attracted to MRI magnets and become a missile hazards, i.e. only objects containing ferromagnetic materials. Entry control FMDS are mounted at the MRI door (or shortly before) and serve to give early warning of potential hazards. These are normally set up to detect objects such as scissors and phones and anything larger. They are particularly effective at detecting ferrous cylinders and non-MR gurneys, wheelchairs, floor buffers etc.
Patient Screening FMDS are normally wall-mounted in the patient changing area or along the route to Zone IV. These check the ferromagnetic integrity of the patients and act as the only objective test of the information on the MRI screening form concerning ferromagnetic objects. The most sensitive models can detect bobby pins, ferromagnetic jewelry and are also effective for detecting pacemakers and other implanted devices.
Any safety tool is only as effective as the person using it, and FMDS are no exception. To have maximum effect FMDS must be a core element of safety policy, processes and procedures. We asked Dr. Mark Keene, Metrasens’ Chief Technology Officer for his views on this: “The training of staff to use FMDS effectively is inextricably linked to general safety training; and this is vitally important.”
“The ACR guidelines on MRI safety recommend the use of FMDS and set them in the context of best practice for general clinical MR safety. New facility designs should be laid out to properly accommodate FMDS, as their effectiveness can be compromised by poor architectural design. ASHE, FGI and the Joint Commission recognize this and therefore require provisions for FMDS to be made.”
You can read more about the current regulatory guidelines for FMDS in our free MRI Safety regulations guide.
FMDS are not designed to replace any of the other essential elements of the MRI safety mix discussed here, but they will provide objective data to educated and attentive MRI professionals, enabling better-informed decision making, reducing ambiguity and staff stress levels.
More work to be done, together
We believe that good teamwork is essential to the formulation and maintenance of effective MRI safety. This encompasses everything we’ve talked about here: sound and repeated education; facilities that are well designed for purpose; and deploying ferromagnetic detection technology that meets published guidelines.
While the patchwork of MRI safety regulation in the USA is becoming more standardized, this trend is earlier in the adoption curve in some other parts of the world. The ACR Guidance document’s recommendations for zones, supervision, access controls, and ferromagnetic detection are largely acknowledged around the globe, but often relegated to the status of ‘above-and-beyond recommendation’ as opposed to minimum standard.
We hope that recent events will focus the minds of senior radiology, regulatory and governmental authorities around the world, most especially in those countries now rapidly expanding their MRI imaging provision.